• Review says average waiting time target will be trialled this year
  • Would replace the 18-week NHS Constitution target if adopted
  • Most recent performance worst since March 2009

NHS England has revealed proposals to axe the 18-week waiting standard for elective care, with an average waiting target introduced instead.

Test sites will measure the average waiting time for patients on the referral-to-treatment pathway, with a view to this replacing the maximum waiting time standard.

Currently, the NHS Constitution says treatment for an elective procedure must happen within 18 weeks. 

But, in practice, this is widely missed and provider trusts have to ensure 92 per cent of their list has not waited more than 18 weeks. This target has not been hit nationally since March 2016.

The proposal announced today will be tested over the next year in pilot sites and is part of the Clinically-led review of NHS access standards interim report produced by NHS England medical director Stephen Powis.

The document said the average wait target would mean “every week counts for all patients in achieving an average, hence keeps focus on patients at all stages of their pathway”.

It continued: “Using an average waiting time, rather than communicating to patients with reference to an upper most length of time that they could wait, may better reflect how long they are actually going to wait.”

There were 4.15m people awaiting treatment for an elective procedure in December, the most recent waiting time statistics showed.

The average wait was 22.7 weeks, the longest since the targets were introduced in March 2009. There were 2,237 people who had waited more than a year.

The report also recommended that all patients who have not been treated within 26 weeks “are able to choose whether to access faster treatment elsewhere in a managed way”.

However, many trusts with long waiting lists have found patients are reluctant to switch to another provider once they have been assigned to the care of a particular consultant.

Because the 18-week targets relate to legal rights, a public consultation will have to take place before any changes can be made.

Dr Powis’ interim report also said the expected transformation in the way outpatient appointments are delivered would change the nature of elective waiting lists.

It said: “The NHS long-term plan sets out to transform the outpatient model with better support to GPs from secondary care clinicians to avoid the need for a hospital referral, single visit consultation and diagnostic visits to replace multiple visits, and alternatives to traditional appointments including digital appointments, where appropriate.”

It said the number of outpatient visits to hospitals had increased from 54m to 94m over the past decade.

Nuffield Trust chief executive Nigel Edwards said: “Given the history of targets having unintended consequences we will need to watch closely as these trials go ahead, looking at the actual effect on people’s health as well as access to care.

“There is a risk that getting rid of the 18-week limit on waits for planned procedures could mean the proportion of people going without care for an unacceptably long time drifts upwards. And we need to be hard-headed about how much difference fine tuning targets will make – the root causes of poor performance lie in a lack of staff and capacity, which we have barely started solving.”

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